Bad Idea of the Day: Drug Testing Welfare Applicants

March 14, 2014

Mississippi lawmakers want to make antipoverty benefits contingent on a clean drug test. A bill currently sitting on Governor Phil Bryant's desk would require applicants to the Temporary Assistance for Needy Families (TANF) program, better known as welfare, to fill out a questionnaire. If the state judged them at risk of substance abuse, they would have to take a drug test—which could land them in treatment and bar them from benefits for up to a year, reports Reid Wilson at The Washington Post. The bill will almost definitely become law: Byrant has already said he expects it to make “a positive difference for families impacted by substance abuse.”

Experts could hardly disagree more. I interviewed Harold Pollack (via e-mail), a health policy scholar at the University of Chicago who has studied substance abuse in the TANF population, and says the overlap is low: contrary to stereotypes, "young men of college age are more likely to have substance use disorders than welfare recipients are." Pollack called the Mississippi bill, and nine others that have passed in Republican-held states, "punitive, non-evidence-based," and "among the worst ideas in American social policy today." Here's our lightly edited conversation.

Nora Caplan-Bricker: Have these programs been shown to impact drug abuse?

Harold Pollack: No, they have not. Population drug testing in the absence of specific indicators has not been shown to provide public health benefit in the TANF population. (I wrote more about this in The Washington Posthere.)

NCB: The prejudiced aspects of the rationale here seem crystal clear, but from what you've seen, is there any more laudable reasoning behind these programs in states that enact them?

HP: Substance abuse disorders are important concerns that requires attention in many populations, including among TANF recipients. Many proponents of drug-testing are surely hoping that such policies can reduce the personal and social costs of alcohol and illicit drug misuse. Nonetheless, such punitive, non-evidence-based policies are among the worst ideas in American social policy today. Were it not for the poisonous politics of public assistance, the poor track record of such efforts in Michigan, Florida, and elsewhere would have put this idea to rest many years ago.

The most striking thing about this debate is how misdirected it is.

Over-reliance on the welfare system is not exactly Mississippi's principal concern. The state's maximum monthly TANF cash benefit for a family of three is $170. The maximum combined value of SNAP and TANF benefits in Mississippi brings families to about 43% of the federal poverty line. We expect single moms to support families on less income than one of my students typically spends on our nine-month cafeteria meal plan.

The politics of impunity towards poor people is especially striking here. It strains credulity that we would subject a less-stigmatized or more influential constituency to the same indignity to which Mississippi wishes to subject applicants to the TANF program. It is especially ironic that Mississippi would pursue these policies while declining to participate in ACA's Medicaid expansion: the single most important policy initiative to provide mental health and substance abuse treatment services to low-income people who are not eligible for public cash aid.

NCB: This program will cost an estimated $36,000 a year. When you weigh the costs against what a program like this does, what's the "bang for your buck"?

HP: I haven't seen a complete analysis of cost-effectiveness. The direct costs of the test kits is probably a secondary issue. The real issues concern the need for follow-up and assessment of those found to test positive. Such policies have in other settings uncovered a very small proportion of people with actual substance use disorders. One can easily saturate the available screening and service resources on casual marijuana users and others who don't really need these services while others in greater need face continued difficulties receiving the help they need for alcohol or drug disorders.

NCB: Mississippi Democrats have expressed concern that this will inadvertently harm children of parents who test positive. Is that a well-founded fear?

HP: Absolutely. There is also the danger that we will deter some parents from seeking contact with public assistance systems. Some policymakers might see this as a benefit of the proposed policies. I see this as a huge missed opportunity to engage people before they come to our attention through child protective services or some other more harmful route.

NCB: What's the greatest harm you see programs like this cause?

HP: These programs build upon, and perpetuate, harmful myths about parents who seek cash assistance. Illicit drug disorders can certainly be found among TANF recipients. Yet these disorders are not particularly widespread among participants in this program. Young men of college age are more likely to have substance use disorders than welfare recipients are.

Drug testing does have an appropriate role when individuals face particular problems in the criminal justice system, sometimes in the workplace, or in particular family situations. Such testing should be provided as part of an evidence-based set of interventions to improve parents' well-being and their ability to successfully navigate their work and family roles. A diffuse, poorly-targeted political effort like this will not accomplish these goals. Instead it dissipates scarce resources.